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Journal of the American College of Cardiology

News & Views

Heart rate and quality of life in patients with AF

Stringency of heart rate control does not influence quality of life (QOL) for patients with permanent atrial fibrillation (AF), according to a study1 published recently in the Journal of the American College of Cardiology.

Researchers led by Hessel F Groenveld (University Medical Center Groningen, the Netherlands) assessed QOL in 437 patients with permanent AF from the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) trial of “strict” versus “lenient” rate control.  QOL was measured using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire, AF severity scale, and Multidimensional Fatigue Inventory-20 (MFI-20) at baseline, 1 year, and end of study.

Findings showed that although straightforward clinical AF symptoms were related to formal QOL measures, both at inclusion as well as during follow-up, symptoms were not affected by stringency of rate control.  Minor changes in QOL during follow-up were related to age, symptoms at baseline and at end of study, severity of underlying disease, and female sex, the authors say.

The authors speculate on possible explanations for their findings, including: that patients with permanent AF may lack typical AF symptoms, limiting the impact of rate control; symptoms may be driven by underlying heart disease rather than the arrhythmia itself; and that controlling rate does not preclude patients from being symptomatic due to ventricular irregularity, and the latter may not be affected by stringency of rate control.

In an accompanying editorial2 Drs Paul Dorian (St Michael’s Hospital, Toronto, Canada) and Andrew Ha (Toronto General Hospital, Toronto, Canada) praise the study, citing as its key clinical lesson the subjectivity of QOL, and of its assessment: “it is insufficient to merely examine the electrocardiogram of patients in AF to assess the impact of their illness on their well-being. For example, a resting ventricular response rate in AF of 100 beats/min does not necessarily imply the patient is worse off than if his or her heart rate was 60 beats/min and should not necessarily prompt the practitioner to intensify rate control therapy”.

“There is no laboratory test, per se, for QOL,” they add.  “Questionnaires used in research studies are valid measures of the seemingly ethereal concept but are impractical for routine clinical use…Clinicians need to be aware that patient personality, treatment expectations, and factors unrelated to the arrhythmia itself will have important, potentially determining influences on the extent to which AF causes suffering”.


1 Groenveld HF, Crijns HJGM, Van den Berg MP, et al. The Effect of Rate Control on Quality of Life in Patients With Permanent Atrial Fibrillation: Data From the RACE II (Rate Control Efficacy in Permanent Atrial Fibrillation II) Study.  JACC 2011;58:1795–803. doi: 10.1016/j.jacc.2011.06.055

2 Dorian P, Ha ACT,Does Better Rate Control Improve Quality of Life?  Be Still My Beating Heart. JACC 2011;58:1804–6. doi:10.1016/j.jacc.2011.06.052

Published on: November 3, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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